Comparative Analysis of Primary Closure, Rhomboid Flap, and Open Technique in Pilonidal Sinus Surgery: A Retrospective Cohort Study

Abstract

Objective: Pilonidal sinus disease (PSD) is a common condition in young adults, with multiple surgical options available. The optimal technique remains debated due to trade-offs between recurrence, healing time, and patient satisfaction. This study aims to compare outcomes of primary closure, rhomboid flap, and open excision in the surgical management of PSD. Methods: A retrospective cohort study was conducted on 300 patients treated between December 2024 and January 2015. Patients were grouped by technique: primary closure (n = 100), rhomboid flap (n = 100), and open excision (n = 100). Baseline characteristics, operative time, postoperative pain (VAS), length of stay, time to complete healing, Time to return to work , complications, recurrence, and satisfaction were analyzed. Statistical tests included Kruskal–Wallis for continuous variables and Chi-square for categorical variables (P < .05). Results: Baseline characteristics were comparable across groups. Operative time was shortest for open excision (42.95 ± 9.98 min) and longest for rhomboid flap (54.35 ± 14.42 min; p < 0.001). Healing time differed significantly (P < .001): rhomboid flap (30.42 ± 5.36 days) and primary closure (36.56 ± 4.73 days) healed faster than open excision (75.75 ± 9.12 days). Return to work followed a similar pattern (P < .001) Pain scores and hospital stay were comparable. Recurrence was lowest with open excision (5.0%) versus primary closure (17.0%) and rhomboid flap (18.0%; P = .011). Satisfaction was highest in rhomboid flap (67% highly satisfied) and lowest in open excision (53%). Conclusion: Open excision offers the lowest recurrence but at the cost of prolonged healing and delayed return to work. Off-midline flap procedures provide faster recovery and higher satisfaction, making it suitable for patients prioritizing early functional outcomes. Technique selection should balance recurrence risk, recovery time, and patient preference.

Keywords

• Pilonidal sinus
• rhomboid flap
• primary closure
• open excision
• recurrence
• wound healing

Pilonidal Sinüs Cerrahisinde Primer Kapatma, Romboyid Flep ve Açık Tekniklerin Karşılaştırmalı Analizi: Retrospektif Kohort Çalışması

Abstract

Amaç: Pilonidal sinüs hastalığı (PSH), genç erişkinlerde sık görülen ve birden fazla cerrahi tedavi seçeneği bulunan bir hastalıktır. Nüks, iyileşme süresi ve hasta memnuniyeti arasındaki denge nedeniyle en uygun cerrahi teknik hâlen tartışmalıdır. Bu çalışmada pilonidal sinüs hastalığının cerrahi tedavisinde primer kapatma, romboid flep ve açık eksizyon tekniklerinin sonuçlarını karşılaştırmak amaçlanmıştır. Yöntemler: Bu retrospektif kohort çalışmasına Aralık 2024 ile Ocak 2025 tarihleri arasında tedavi edilen 300 hasta dâhil edildi. Hastalar uygulanan cerrahi tekniğe göre üç gruba ayrıldı: primer kapatma (n=100), romboid flep (n=100) ve açık eksizyon (n=100). Ameliyat süresi, postoperatif ağrı (VAS), hastanede kalış süresi, tam iyileşme süresi, işe dönüş zamanı, komplikasyonlar, nüks oranı ve hasta memnuniyeti değerlendirildi. İstatistiksel analizde Kruskal–Wallis ve Ki-kare testleri kullanıldı. Bulgular: Gruplar arasında demografik özellikler açısından anlamlı fark yoktu. Ameliyat süresi açık eksizyon grubunda en kısa, romboid flep grubunda en uzun bulundu (P < ,001). İyileşme süresi romboid flep ve primer kapatma gruplarında açık eksizyona göre anlamlı olarak daha kısaydı (P < ,001). İşe dönüş süresi benzer şekilde daha hızlıydı. Ağrı skorları ve hastanede kalış süresi gruplar arasında farklılık göstermedi. Nüks oranı açık eksizyonda en düşükken (%5,0), primer kapatma (%17,0) ve romboid flepte (%18,0) daha yüksekti (P = ,011). Hasta memnuniyeti romboid flep grubunda en yüksekti. Sonuç: Açık eksizyon düşük nüks oranı sağlarken, daha uzun iyileşme süresi ile ilişkilidir. Off-midline flep teknikleri daha hızlı iyileşme ve daha yüksek hasta memnuniyeti sunmaktadır.

Keywords

• Pilonidal sinüs
• romboid flep
• primer kapatma
• açık eksizyon
• nüks
• yara iyileşmesi

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